Project Summary: Certain segments of the population have persistent increased cervical cancer incidence and mortality rates because women living in the U.S. have not benefited equally from cervical cancer screening, follow-up of abnormal Pap smears, and HPV vaccination. One example of a population group still experiencing elevated cervical cancer rates is women living in the Appalachian region of the U.S.. The Ohio State University (OSU) Center for Population Health and Health Disparities (CPHHD), Community Awareness, Resources, and Education (CARE I) was focused on why women living in Ohio Appalachia have an elevated burden from cervical cancer. From CARE I, we learned that Ohio Appalachia women have a high prevalence of HPV types 6,11,16,18 compared to U.S. rates, respectively (12.0% vs. 3.4%). Thus, HPV is a major problem in this population, and ways to address HPV elevated rates are needed. A transdisciplinary health disparities research team at OSU and community partners from Ohio Appalachia propose to conduct "STEPS" (Study To Examine Parent/Provider Systems). "STEPS to prevent cervical cancer" will address the cervical cancer burden in Ohio Appalachia by focusing on improving HPV vaccination rates among young girls and female adolescents by using a multi-level intervention approach delivered in health departments. The goal of this proposal is to develop and test a culturally appropriate multi-level educational intervention intended for parents (level 1) of young girls living in Ohio Appalachia who seek care at participating health departments, health care providers (level 2) practicing at these health departments, and health departments (level 3) in Ohio Appalachia to increase HPV vaccination rates among young girls and female adolescents. The specific aims are to: 1) Develop the multi-level HPV vaccine educational intervention directed at 3 levels within participating health departments that includes information about cervical cancer, cervical cancer screening, HPV, the HPV vaccine, communication skills training to improve parent-health care provider conversations about the HPV vaccine, and organizational level components;and 2). Evaluate the effectiveness of the multi-level HPV vaccine educational intervention in a group randomized controlled trial in 12 Ohio Appalachia public health departments. Specific aims will be carried out using community-based participatory research (CBPR) principles and in partnership with parents, health care providers, and health departments in Ohio Appalachia. If effective, this multi-level intervention could be disseminated and used to improve the delivery of the HPV vaccine in other Appalachian locations and address the elevated cervical cancer rates in Appalachia. This project is in line with the theme of the renewal of the OSU CPHHD, reducing cervical cancer in Appalachia, using a Social Determinants of Health conceptual model and building upon the results of CARE I.